Outline

Objective: We report two cases of intraspinal angiolipoma adding to the scarce case descriptions of this entity.

Methods: A 14-year-old boy presented with a subacute paraplegia without loss of sensitivity, associated with high thoracic pain and urinary disturbances. MRI revealed an intraspinal extradural left-sided tumour at T1-3 level displacing the myelon and showing moderate contrast enhancement. On instant operation including osteoplastic laminotomy at T1-4 level a grey and massively vascularized epidural tumour with adipose tissue components was subtotally excised, demanding extensive intraoperative hemostasis. Paraplegia was completely reversible, MRI controls up to 31 months postoperatively revealed residual tumour without progression or compression of the myelon. An 11 month old boy presented with deterioration in crawling and standing, reduced spontaneous motion of the upper extremities and a constant anteflexion of the cervical spine, CSF showed increased protein content without pleocytosis. MRI disclosed an epidural space occupying process between C2 and T5 level including a separable process at T7 level with marginal contrast enhancement. A non-coagulated epidural hematoma was evacuated, at T7 level a small epidural tumour excised. The postoperative course was characterized by an epidural rebleeding necessitating evacuation and by a residual paresis of the right upper extremity.

Results: Histological evaluation in the first case demonstrated dilated vessels, primarily of venous phenotype, amongst fat tissue. In the second case the small tumour giving rise to the epidural hematoma was found to contain richly vascularized adipose tissue with siderophages, collagenous and elastic fibres.

Conclusions: The histologies correspond to spinal angiolipomas, benign tumours composed of mature adipose and abnormal vascular elements, representing a distinct rare entity and between 0.04% and 1.2% of all spinal axis tumours. The two cases reported underline the possibly acute clinical presentation of these tumours due to myeloncompression or spontaneous hemorrhage.